The findings mean that scars in the esophagus due to eosinophilic esophagitis (EoE) can be found earlier, allowing for more targeted intervention.
A recent study using a currently approved FDA gastrointestinal (GI) device showed that it can also be used to measure the extent of early esophageal scarring in pediatric patients with eosinophilic esophagitis (EoE).
The Endoscopic Functional Luminal Impedance Probe (EndoFLIP) measures simultaneous pressure and diameter to diagnose and treat various upper GI tract conditions. The ductility index (DI) is a functional measure of how much force (mm2/mm Hg) is needed to open the esophagus.
Sign up Clinical gastroenterology and hepatologyresearchers in Chicago said that previously the extent of scar tissue in the esophagus could only be assessed visually during endoscopy, making it challenging to detect early scarring and intervene before damage progresses, leading to the development of esophageal rings and stricture , which can cause solid foods to be affected.
Symptoms of fibrostenosis, a complication of chronic EoE, are highly variable and can contribute to esophageal dysfunction, even if the early stages go undetected on endoscopy.
The researchers analyzed a prospectively recruited group of 59 patients aged 9 to 21 who underwent upper endoscopy and EndoFLIP for suspected or previously diagnosed EoE to assess whether esophageal DI can be used to define fibrostenotic severity. The DI is not affected by age in children older than 9 years, they noted.
“In pediatric EoE, the utility of esophageal dilatability as a tool for clinical phenotyping remains unclear,” they wrote. “Further, it is unknown how esophageal distensibility in pediatric EoE relates to clinically determined parameters of fibrosis, including symptoms of esophageal dysfunction, endoscopic rings, and subepithelial fibrosis on biopsy.”
The results showed that the DI was significantly lower in patients with fibrotic compared to inflammatory features on endoscopy (median [IQR]3.3 (2.3-4.4) vs. 5.5 [4.1-6.0]; P = .02) and showed no correlation with eosinophil count.
The researchers were able to propose a criterion for a stiff esophagus in children with EoE, writing that a DI of less than 4.5 mm2/mm Hg predicted grade 2 rings on endoscopy with area under the curve (AUC) of 0.81 (P = .0004). DI predicted food impact in both unadjusted and adjusted models (fully adjusted odds ratio, 1.44; 95% CI, 1.02-2.14; P = .0486).
“This is a game changer in how we care for children with EoE,” senior author Joshua Wechsler, MD, MSCI, medical director of the Eosinophilic Gastrointestinal Diseases Program at Lurie Children’s and assistant professor of pediatrics at Northwestern University Feinberg School of Medicine , said in a statement. “Now if the extensibility is low, we can dilate the esophagus during the same procedure, and because we can locate exactly where the scars are, our intervention is more targeted and takes much less time. We’re seeing improvements in symptoms, which is incredibly exciting.
Hoffmann NV, Keeley K, Wechsler JB. Esophageal distensibility defines fibrostenotic severity in pediatric eosinophilic esophagitis. Clin Gastroenterol Hepatol. Published online September 16, 2022. doi:10.1016/j.cgh.2022.08.044